Thursday, July 3, 2008

Measles Successfully Contained; Child Recovered

By Joe Pyritz

FLORENCE – Pinal County Public Health officials are announcing the successful containment of measles to just one case in Pinal County.  On May 15, 2008, Pinal County identified a case of measles in an unvaccinated child living in the San Manuel area.  The child has now fully recovered. 


It is believed this case is associated with the outbreak of measles that is ongoing in southern Arizona.  By late June, two full incubation periods had elapsed since the case, making it possible to declare the county free of measles.


"There was just one confirmed case of measles in Pinal County," said Pinal County Public Health Director Tom Schryer.  "Our Public Health staff deserves credit for successfully containing this to one case by being thorough and proactive."


Numerous other suspects were ruled out as not having measles, according to Schryer.  Fewer than ten individuals had symptoms suspicious enough to result in additional testing.  He added that there are currently no suspected cases under investigation at this time in Pinal County.


In July 2007, the Pinal County Board of Supervisors approved the formation of the Pinal County Public Health District, which enabled the Health & Human Services Division to build a more robust, proactive public health program. 


What did Pinal County do to investigate the case?


Pinal County Infectious Diseases and Epidemiology was notified by the Arizona Department of Health Services (ADHS) about a positive lab result in a child who had symptoms consistent with measles.  The child had been seen in a hospital in Tucson where specimens had been pulled for testing. 


Pinal County immediately started a contact investigation to identify anyone who might have been exposed and could be at risk of contracting disease.


  • Health officials contacted the child's mother and interviewed her about everywhere the child had been while infectious.
  • They identified 55 people who had contact with the child while it was infectious.
  • Calls were placed to all people identified as exposed to inform them, provide information on measles, answer questions and inquire about immunization status.  A standardized questionnaire is used when interviewing contacts.  The initial call and interview usually takes between 20 and 30 minutes.  If someone was not immunized or could not produce proof of immunization, the county offered free immunization through its public health clinics.  A total of 20 vaccinations were provided to identified contacts,
  • Contacts were instructed to watch for symptoms and contact Pinal County Public Health if they developed any symptoms.  They were also told to stay home if a fever developed to ensure that secondary spread did not occur.  
  • Daily calls were made for 21 days after exposure to any previously unvaccinated contacts to make sure they remained asymptomatic.
  • At 21 days after exposure, all contacts were called again to make sure they never developed symptoms and to inform them that the incubation period was over.
  • No additional cases or secondary spread have been identified.


How did Pinal County stop spread of this disease? 


Multiple control measures are used by the County to prevent the spread of infectious diseases: 

  • Public Health officials perform a "contact investigation" to identify individuals who may have had contact with the infected person.  They may be at risk of contracting the infection so officials attempt to keep them from getting sick, and if they do get sick, ensure that they don't expose others.  Time is critical with the contact investigation.  Pinal County had identified and contacted all exposed individuals within 72 hours after notification of the case.
  • Pinal County recommended an accelerated measles vaccination schedule for children as soon as the case was identified.
  • Public Health representatives called local clinics, urgent care facilities and emergency departments to inform them of the situation, provided information on measles and accelerated vaccination, and asked them to be on the lookout and to call in anything suspicious.  This ensures that the County can identify any new cases or suspects quickly and to make sure that cases are not being missed.
  • Pinal County provided information to the public through the county's hotline and Citizen Contact Center, website and through the news media.
  • After cases were found in Pima County, Public Health verified immunity to measles for designated county staff in the event that Pinal County would have an infected resident.


Why is measles a big deal?  Why do you vaccinate?


Measles is one of the most contagious diseases that we know of.  It is spread through the air, primarily from an infected person coughing, and can linger in the environment for hours.  While most infections are uncomplicated, it can potentially be very serious and cause pneumonia, blindness, encephalitis and, rarely, death.  Measles will kill between 2 and 3 of every 1000 people that contract the disease.  Vaccination has greatly reduced the number of cases occurring in the United States since its inception. 


How do you handle a suspected or possible case?


When a physician, school official, resident or others call suspecting measles, Public Health officials evaluate the symptoms to determine if they are consistent with measles.  If symptoms are suspicious of measles, a field team from the infectious diseases section is sent out to evaluate symptoms firsthand, interview the family and draw specimens for testing.  Each suspect is evaluated using symptoms and lab testing to determine if it is a case.  


How many shots were given at county clinics?


Since May 1, Pinal County Public Health has provided over 400 doses of the MMR vaccine to residents through our public health clinics.


How many people worked on this investigation?


Many county employees were involved in the response to this measles case.  The infectious diseases and epidemiology section performed the contact investigation, coordinated immunization for contacts, implemented control measures, and investigated other reports of rash illness in the county.  Pinal County staff also routinely consulted with ADHS concerning the situation.


Clinic staff provided vaccination to identified contacts and to others that came to public health clinics for immunizations.  Public health preparedness staff facilitated communication within the county and to the public.  Staff from the Pinal County Citizen Contact Center took calls from the public, answered questions and routed calls with specific questions to the appropriate people. 


When should children be vaccinated?  


Since there has been no secondary transmission of measles in the county, Pinal County is now recommending returning to a routine childhood vaccination schedule.  This means that a child should get the first dose of MMR as soon as possible after their first birthday.  A second dose should be administered before beginning school.


For information on immunizations or the locations of Pinal County Public Health clinics, call 520-509-3555 or 888-431-1311.





Comments from the Board of Supervisors


Chairman David Snider, District 3 Supervisor:  "The successful effort to control and mitigate this outbreak of measles is not only critical to our continuous campaign to support the health and well-being of our residents, it's also an investment in our economic well-being.  Healthy residents are able to go to work on a daily basis, attend our educational institutions, and pursue their normal lives without fear of epidemic or contagious diseases.  I want to thank and congratulate all of the health care providers that worked tirelessly to make sure that there was no spread of measles beyond the unfortunate single case."


Supervisor Lionel Ruiz, District 1 Supervisor:  "The cooperation of the family, the general public, state health officials and the medical contributed to a successful outcome.  I am pleased that the young child with measles has recovered from the illness and no other children or adults were affected."


Supervisor Sandie Smith, District 2 Supervisor:  "This situation underscores the reasons we created the Public Health District with the goal of increasing the number of fully-immunized children.  Vaccinating your child protects against serious and deadly diseases and prevents the spread of preventable diseases."